9/14/2014 Anaphylaxis: a guide to management : Page 5

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Anaphylaxis: a guide to management
1. A 61 year old man comes to see you. He is in great discomfort and unable to pass urine. On examination, he has a distended and tender bladder. You diagnose acute
urinary retention and insert a urinary catheter. Within a few minutes he becomes acutely breathless with marked facial and tongue oedema and a widespread
urticarial rash. He tells you that he ate a prawn mayonnaise sandwich three hours earlier.
What is the most likely cause of his symptoms?
Your answer
Correct
answer
a. Shellfish allergy
b. Egg allergy
c. Vasovagal reaction
d.
Chlorhexidine allergy
a : Shellfish allergy
The history of food ingestion is slightly too long to have contributed to the allergic reaction.
b : Egg allergy
The history of food ingestion is slightly too long to have contributed to the allergic reaction.
c : Vasovagal reaction
It is possible that he had a vasovagal reaction to the procedure, but facial and tongue oedema are more consistent with an allergic reaction.
d : Chlorhexidine allergy
The most likely cause of his reaction is chlorhexidine allergy since his reaction occurred immediately after you inserted a urinary catheter. Anaesthetic gels used for
catheterisation typically contain chlorhexidine. Chlorhexidine is widely used to decontaminate the skin and is present in a wide range of medical products and
devices. These include antiseptic mouth washes, antiseptic wipes and dressings, and central venous catheters. Chlorhexidine is increasingly recognised as a cause of
allergic reactions during medical or dental procedures. [ 4 ]
It is also important to consider latex as a possible cause of allergic reactions. Although the introduction of powder-free and low-protein gloves has reduced rates of
sensitisation to latex it remains an important cause of allergic reactions in healthcare settings and during general anaesthesia. [ 5 ] [ 6 ]
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9/14/2014 Anaphylaxis: a guide to management : Page 5
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